Purpose: Lower extremity reconstruction using microvascular techniques is often the only option for limb salvage. This study retrospectively analyzed patients treated at a single institution who underwent lower limb salvage with microsurgical techniques. Of particular interest are the outcome data for patients who had initial free flap failure.

Methods: Records from a prospective database were reviewed from 1980 through 2004. All patients with free flaps to the lower extremity were identified.

Results: Five hundred eighty eight patients who underwent microsurgical reconstruction of lower extremity wounds had a failure rate of 8.5%. Trauma patients (83 percent) had a failure rate of 9%. The failure rate for trauma patients decreased from 11 percent (1980-1992) to 3.7 percent (1993-2004). Of patients who had a failed free flap, 18 percent went on to limb amputation; the remainder were salvaged with secondary free flaps, local flaps, or skin grafting.

Conclusion: This single institutional experience spanning 25 years represents the longest continual series of lower extremity free flaps. The improved success rate seen in the second half of the study period is attributed to a more critical selection of free flap candidates, improved understanding of the physiology surrounding acute trauma and a more sophisticated multidisciplinary approach.